云计算在电子健康中的新应用

在医疗健康信息爆炸式增长的电子健康时代,如何获取存储分析与管理医疗健康数据,并以更低的}T成本实现更加智能、更为个性化的医疗健康服务成为未来电子健康发展的重要课题。云计算作为新兴的信息技术为应对上述挑战提供了新的技术途径。对电子健康领域中基于云计算的新型电子健康应用服务进行了介绍,讨论了云计算对电子健康未来发展的趋势性影响。     

关于中国发展人本电子健康的战略思考与对策建议

人本电子健康(HeH)是支持医学模式转变的战略导向和强大技术平台,是中国医疗体制改革的治本之策,将有利于创建新型的知识与技术创新体系,引领未来社会发展新模式。推进HeH需要通过国家的战略部署和区域化试点,大力发展数字化医疗保健设备,加快推进人口与健康领域国家级数据共享平台建设,建立并完善社会支助体系。     

Examining the Influence of E-Health Education on Professional Practice

e-Health is steadily integrating into modern health services, making significant changes in the way health services are traditionally delivered. To work in this new environment, healthcare workers are required to have new knowledge, skills and competencies specific to e-Health. The aim of this study was to understand the self-reported perceptions of graduates regarding the influence of an e-Health postgraduate program on their professional careers. In addition, this paper will provide an overview of the e-Health postgraduate program. All graduates from 2005 to 2015 were surveyed using an online questionnaire that consisted of a mixture of closed and open-ended questions. The number of participants in the study was 32. Response rate was 62%. The main motivating factors for studying e-Health were ‘relevance to current practice’ and ‘e-Health is the future’. The participants noted that the opportunity to ‘acquiring relevant knowledge’ and ‘having exposure’ were key benefits offered by the e-Health education program. The majority of graduates (n?=?23, 72%) thought that the postgraduate e-Health program had an influence on their professional practice. A similar number of participants (n?=?23, 72%) mentioned that they had worked in the field of e-Health since their graduation. Their professional roles mainly involved ‘implementation of e-Health in health service settings’ and the ‘use of e-Health in clinical practice’. While e-Health may be steadily integrating into modern health services, e-Health specific job opportunities are still relatively limited. e-Health workforce development must be given priority.     

The State of Medical Informatics in India: A Roadmap for Optimal Organization

In India, the healthcare delivery systems are based on manual record keeping despite a good telecommunication infrastructure. Unfortunately, Indian policy makers are yet to realize the importance of medical informatics (including tele-health, which comprises e-Health and Telemedicine) in delivering healthcare. In the medical curriculum also, nowhere is this treated as a subject or even as a tool for learning. The final aim of most of the medical and paramedical students should be to become good users, and if possible, also experts for advancing medical knowledge base through medical informatics. In view of the fast changing world of medical informatics, it is essential to formulate a flexible syllabus rather than a rigid one for incorporating into the regular curriculum of medical and paramedical education. Only after that one may expect all members of the healthcare delivery systems to adopt and apply medical informatics optimally as a routine tool for their services.     

英国卫生服务购买经验及启示

战略性购买是我国提高医保资金利用效率的关键举措。英国卫生筹资制度虽然不是社会医疗保险模式，但其卫生服务购买组织--临床委托服务组织（CCGs）为我国实施战略性购买提供了一些有益的经验。推行初级卫生保健是实现“人人享有卫生保健”的关键和基本途径。全科医生加入并领导CCGs使得采购组织能够直接了解患者需求，而且有能力跟卫生服务提供方对话，这是实施战略性购买的基本前提。另外，CCGs是自下而上由全科诊所自发形成的，有不同的规模和治理结构，完全基于各地的实际需要并有助于满足群众的需要，有利于确保服务质量的持续改进、减少不公平、保障选择权和患者参与，并促进整合型卫生服务的提供，减少住院服务利用，提高资金利用效率。     

Better Physical Activity Classification using Smartphone Acceleration Sensor

The evolution of wireless communication technologies opened the way to the definition of innovative e-Health systems aimed at providing a continuous and remote support to patients and new instruments to improve the workflow of the medical personnel. Nowadays, pervasive healthcare systems are a major step in this regard. The safety-critical systems on one hand and their failure in communication (i.e. sending and receiving messages) in other hand may lead to disaster results in the systems. Moreover, the need for high quality services in such systems, and the access to various types of Quality of Services such as reliability in software development has been increasing in the past years. In this paper, firstly we extend the core meta-model of the previously designed style for designing the structures of such systems in order to reach a high level of reliability in messaging. Secondly, their configuration mechanisms in controlling the communicative errors will be modeled using graph transformation rules. Finally, the correctness of the model is analyzed by model checking techniques. The results of the analysis show its high reliability.     

论医学伦理学、生命伦理学在医疗卫生事业中的基础性与战略性地位——中国医学伦理学与生命伦理学发展研究之一

医学伦理学、生命伦理学在医疗卫生事业中具有基础性和战略性地位,这一命题正在成为学术界和医疗卫生界的共识.对这一命题从医学的使命与目标、医疗卫生事业的公益性、医改的成败得失、道德资本和德源资产等多重维度进行了阐述.     

电子健康及其发展研究

近几年电子健康体系建设引起广泛关注并取得成效。系统介绍电子健康发展历程,结合存在的一些问题探讨如何完善电子健康体系。通过现状分析对电子健康未来发展趋势进行展望,即发展人本电子健康,并就如何发展人本电子健康事业提出建议。     

Methods to Evaluate Health Information Systems

为了保证卫生信息系统引进的顺利进行,达到预期的目的,有必要在系统引进的每个阶段对影响系统成功引进的关键因素进行评估.基于系统性的文献分析研究和自身多年对卫生信息系统评估工作的经验,提出一个以笛伦和麦克伦信息系统成功模型为基础的整合多元方法的评估方案.这个方案的优势在于它不仅能分辨决定卫生信息系统成功引进的因素,而且能将不同因素的影响程度量化,从而产生对影响因素有轻重缓急之分的评估结果.该结果有利于决策者及时处理解决系统引进不同时期出现的关键问题.这种有量化证据支持的决策行为将有效地降低卫生信息系统引进失败的可能性,进而增大卫生信息系统的投入产出回报.     

The Adoption and Implementation of RFID Technologies in Healthcare: A Literature Review

Radio Frequency Identification (RFID) technology not only offers tracking capability to locate equipment, supplies and people in real time, but also provides efficient and accurate access to medical data for health professionals. However, the reality of RFID adoption in healthcare is far behind earlier expectation. This study reviews literature on the use of RFID in healthcare/hospitals following a formal innovation-decision framework. We aim to identify the common applications, potential benefits, barriers, and critical success factors. Our study facilitates quick assessment and provides guidance for researchers and practitioners in adopting RFID in medical arenas. Many earlier adopters in healthcare found RFID to be functional and useful in such areas as asset tracking and patient identification. Major barriers to adoption include technological limitations, interference concerns, prohibitive costs, lack of global standards and privacy concerns. Better designed RFID systems with low cost and privacy issues addressed are needed to increase acceptance of RFID in healthcare.     

上海25所公立医院对平衡记分卡的认知度调查

目的了解平衡记分卡(BSC)作为战略管理手段在医务人员中的认知度和认同度。方法通过问卷调查收集上海市25所公立医院848位医务人员对战略管理和BSC的认知信息,并进行方差分析和多因素回归分析。结果对战略目标的认可度,管理人员和普通员工之间不存在统计学差异(P>0.05);而不同等级医院间具有显著差异(P<0.01),其中三级医院对战略目标的认可度最高。共有83人明确表示了解BSC的内容,管理者对BSC的认知度显著高于普通员工(P<0.001);参加过管理培训的人员和管理者对BSC的认知度较高;其中62人认为BSC可应用或改进后应用于我国的医疗机构。结论绝大多数医务人员认同战略管理的思路,但对BSC认知度较低,可通过加强宣传力度来扩大BSC的认知度。     

“互联网+”医疗服务的国际经验及借鉴

在"互联网+"医疗服务过程中,医疗实践实现了民主化、去中心化和去神秘化。发达国家和地区"互联网+"医疗服务的应用重组了医疗服务的商业供给模式,有效提升了医疗服务的质量和个体化发展。发展中国家"互联网+"医疗服务的推广和使用极大地扩宽了专业医疗救助服务和预防保健康复医疗服务的范围,保障了居民健康从而促进经济快速发展。作者通过梳理发达国家和地区"互联网+"医疗服务的概念内涵、发展历程和发展经验,为国内"互联网+"医疗服务发展提供参考借鉴。     

ITU e-Health Training Program for Pacific Island Community with the Support of the Sasakawa Peace Foundation

Tokai University School of Medicine provided a short-term e-Health training program for persons from Pacific Island Nations from 2006 until 2008 supported by funds from the Sasakawa Peace Foundation. There were lectures on software, hardware and topics relating to e-Health. We could assess the current medical situation in the Pacific Islands through this training course, and also obtain relevant material to analyze appropriate measures deemed necessary to improve the situation.     

Simulating Staffing Needs for Surgical Instrument Distribution in Hospitals

Timely and accurate delivery of surgical instruments to operating rooms is critical for success in surgical operations in hospitals. The National Hospital of Singapore was facing several problems in the process of surgical instrument distribution on ad hoc orders from operating rooms. To solve the problems, the Hospital management considered adopting a new process of surgical instrument distribution on ad hoc orders that involves staffing new healthcare assistants for delivery of surgical instruments to operating rooms. Using computer simulation, this study assessed the efficiency of the new process and recommended the optimal number of healthcare assistants needed for delivery of surgical instruments on ad hoc orders, at which healthcare assistants as well as surgical instruments could be most efficiently utilized. The results show that computer simulation is an effective tool supporting decisions on staffing needs for surgical instrument distribution in hospitals.     

人本电子健康系统构建

阐述电子健康对于健康管理的重要性，调研并总结国内外在电子健康系统构建方面的经验与不足，提出人本电子健康系统的创新性并给出其系统设计。该系统分为个人健康日志与问卷调查、科普知识与案例、健康论坛3大部分，每个模块分别承担不同的功能。     

MyHealthRecord in Australian Primary Health Care: An Attitudinal Evaluation Study

Australia’s investment in the national MyHealthRecord has not been successfully communicated to the myriad of stakeholder groups, resulting in negative perceptions about the system and serious consequences for the uptake of the MyHealthRecord. Local stakeholder attitudes and perceptions will be crucial in setting the scene for success or failure with MyHealthRecord. A survey was undertaken to identify primary healthcare provider perceptions of the MyHealthRecord system, and capture the perceived enablers and barriers for use of the MyHealthRecord system. Almost all (89%) of the twenty-seven (27) respondents had previously heard of the MyHealthRecord system prior to completing the survey. Enablers included a decrease in duplication of effort and an increase in continuity of care. However, concerns about the perceived impact on healthcare provider time, privacy, access controls, and the need for full participation will need to be managed if MyHealthRecord is to be successfully implemented. The MyHealthRecord system will only be perceived as trustworthy when there is full participation by healthcare organisations, providers, and consumers. If Australian consumers become participants in an opt-out approach, it will be a catalyst for participation by healthcare organisations and providers. Incentives to encourage MyHealthRecord participation need to be extended to all healthcare providers as healthcare provider attitudes are influential with consumers. Therefore MyHealthRecord training and education needs to be targeted towards healthcare providers. Research into the attitudes of the local healthcare provider cohort is valuable in creating a change management strategy for maximising local success.     

电子健康挖掘研究述评

从药物副作用挖掘、疾病爆发监控、消费者健康词汇表构建、缩写消歧和拼写错误检测以及情感分析和观点分析5个应用领域,对电子健康挖掘研究进行系统介绍,以期对国内相关研究起到一定的促进作用.     

Analysis of Cloud-Based Solutions on EHRs Systems in Different Scenarios

Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud.     

Towards an e-Health Cloud Solution for Remote Regions at Bahia-Brazil

This paper presents CloudMedic, an e-Health Cloud solution that manages health care services in remote regions of Bahia-Brazil. For that, six main modules: Clinic, Hospital, Supply, Administrative, Billing and Health Business Intelligence, were developed to control the health flow among health actors at health institutions. They provided database model and procedures for health business rules, a standard gateway for data maintenance between web views and database layer, and a multi-front-end framework based on web views and web commands configurations. These resources were used by 2042 health actors in 261 health posts covering health demands from 118 municipalities at Bahia state. They also managed approximately 2.4 million health service ‘orders and approximately 13.5 million health exams for more than 1.3 million registered patients. As a result, a collection of health functionalities available in a cloud infrastructure was successfully developed, deployed and validated in more than 28% of Bahia municipalities. A viable e-Health Cloud solution that, despite municipality limitations in remote regions, decentralized and improved the access to health care services at Bahia state.     

Using Machine Learning Classifiers to Assist Healthcare-Related Decisions: Classification of Electronic Patient Records

Surveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical and developmental history of patients. Each SL is associated with specific educational and clinical measures. The objective of the present paper was to verify computer-aided, automatic assignment of SLs. The present paper proposes a computer-aided approach for automatic recommendation of SLs. The approach is based on the classification of information from patient electronic records. For this purpose, a software architecture composed of three layers was developed. The architecture is formed by a classification layer that includes a linguistic module and machine learning classification modules. The classification layer allows for the use of different classification methods, including the use of preprocessed, normalized language data drawn from the linguistic module. We report the verification and validation of the software architecture in a Brazilian pediatric healthcare institution. The results indicate that selection of attributes can have a great effect on the performance of the system. Nonetheless, our automatic recommendation of surveillance level can still benefit from improvements in processing procedures when the linguistic module is applied prior to classification. Results from our efforts can be applied to different types of medical systems. The results of systems supported by the framework presented in this paper may be used by healthcare and governmental institutions to improve healthcare services in terms of establishing preventive measures and alerting authorities about the possibility of an epidemic.